Surgical management of complications of endoscopic sphincterotomy with precut papillotomy.
We reviewed 574 endoscopic sphincterotomy procedures. Fifty-six precut papillotomies were performed. Presenting conditions included choledocholithiasis, cholangitis, benign and malignant papillary strictures, and stenosing papillitis. Complications were identified in 16 percent: perforation in 9 percent, pancreatitis in 5 percent, bleeding in 2 percent, and pancreatic abscess in 2 percent. One patient died. Six patients required operation for complications. Perforation of the duodenum or common bile duct seen within 8 hours was managed with drainage and closure of the perforation with minimal complications. Duodenal perforations operated on later than 8 hours required more extensive procedures. All these patients had significant post-operative complications. Three patients were managed nonoperatively. Precut papillotomy carries a significantly higher complication rate than conventional sphincterotomy. Our experience suggests that there is no place for conservative management of duodenal perforation.
Booth
F V
FV
Department of Surgery, State University of New York, Buffalo General Hospital 14203-1154.
Doerr
R J
RJ
Khalafi
R S
RS
Luchette
F A
FA
Flint
L M
LM
D000368:Aged; D014670:Ampulla of Vater / Q000601:surgery*; D004386:Duodenum / Q000293:injuries; D005260:Female; D006470:Hemorrhage / Q000209:etiology / Q000628:therapy; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology / Q000601:surgery; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000209:etiology / Q000628:therapy; D011183:Postoperative Complications; D013105:Sphincterotomy, Transduodenal / Q000009:adverse effects*